NPIMap

Organization Active NPI

Michael J Decicco MD PLLC

  • Otolaryngology Physician
  • Geneva, NY
National Provider Identifier
1417099136
Registry record updated Aug 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
220674 Issued in NY
Legal business name
MICHAEL J DECICCO MD PLLC
Practice address
200 North St
Suite 301
Geneva, NY 14456-1561
Phone
(315) 787-5353
Fax
(315) 315-7875
NPI assigned
Feb 12, 2007
Last updated
Aug 22, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael J Decicco, MDNPI 1255355202
Title
Owner
Phone
(315) 787-5353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X 220674 NY Primary
Pediatric Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YP0228X 220674 NY
Facial Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YS0123X 220674 NY

Addresses

Primary practice location

200 North St
Suite 301
Geneva, NY 14456-1561

Mailing address

67 Kendall Street
Suite 200
Clifton Springs, NY 14432
Phone (315) 462-9482

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1417099136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 KENDALL STREET",
            "address_2": "SUITE 200",
            "city": "CLIFTON SPRINGS",
            "state": "NY",
            "postal_code": "14432",
            "telephone_number": "315-462-9482",
            "fax_number": "315-462-5438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NORTH ST",
            "address_2": "SUITE 301",
            "city": "GENEVA",
            "state": "NY",
            "postal_code": "144561561",
            "telephone_number": "315-787-5353",
            "fax_number": "315-315-7875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J DECICCO MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "DECICCO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-787-5353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "220674",
            "primary": true
        },
        {
            "code": "207YP0228X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "NY",
            "license": "220674",
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "NY",
            "license": "220674",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Geneva, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.